Method for repairing bone defects

ABSTRACT

A method for repairing a soft tissue or bone defect can include selecting one of a plurality of sizing guides having a base perimeter size corresponding to a size of the defect, where each base has a different perimeter size and a plurality of apertures spaced apart a predetermined distance from each other, with the predetermined distance being the same for each of the sizing guides. The selected sizing guide base can be positioned against a distal end of the femur relative to the defect. A plurality of guide wires can be positioned through the plurality of apertures in the sizing guide base and the guide wires can be fixed to the femur such that the guide wires are parallel to each other. A first guide can be positioned over the guide wires and against the distal end of the femur to guide a first cutting member relative to the femur.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is related to U.S. patent application Ser. No.13/169,075 filed on Jun. 27, 2011, now U.S. Pat. No. 8,728,084 issued onMay 20, 2014, entitled “Apparatus for Repairing Bone Defects” and filedconcurrently herewith and incorporated by reference herein.

FIELD

The present disclosure relates generally to a method for repairing softtissue and/or bone defects, and more particularly to a method forrepairing cartilage and/or bone defects in a knee joint.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

Articular cartilage enables bones to move smoothly relative to oneanother, as is known in the art. Damage to articular cartilage, such asin a knee joint, can be caused by injury, such as tearing, by excessivewear, or by a lifetime of use. Such damage to the articular cartilagecan also cause damage to the underlying bone. The damaged articularcartilage can lead to, in certain circumstances, pain and reducedmobility. Various surgical procedures have been developed to repairdamaged articular cartilage, such as microfracture, OATS, mosaicplastyor a unicondylar or partial knee replacement.

While these surgical procedures are effective for their intendedpurpose, there remains a need for improvement in the relevant art fortreating focal defects in articular cartilage in a minimally invasivemanner.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

In one form, a method for repairing a soft tissue or bone defect isprovided according to the teachings of the present disclosure. Themethod can include selecting one of a plurality of sizing guides havinga base perimeter size corresponding to a size of the defect, where eachbase has a different perimeter size and a plurality of apertures spacedapart a predetermined distance from each other, with the predetermineddistance being the same for each of the plurality of sizing guides. Thebase of the selected one of the sizing guides can be positioned againsta distal end of the femur relative to the defect. A plurality of guidewires can be positioned through the plurality of apertures in the baseof the selected one of the sizing guides and the plurality of guidewires can be fixed to the distal end of the femur such that theplurality of guide wires are parallel to each other. A first guide canbe positioned over the plurality of guide wires and against the distalend of the femur to guide a first cutting member relative to the femur.

In another form, a method for repairing a soft tissue or bone defect isprovided according to the teachings of the present disclosure. Themethod can include forming a reference pocket in a distal end of a femurrelative to the soft tissue or bone defect, where the reference pocketis configured to receive a femoral implant. A first cutting member canbe guided relative to the reference pocket to form a bore through thefemur in a first direction relative to the femur. The method can furtherinclude maintaining the first cutting member in the femur and using thebore formed in the femur to guide the first cutting member in a seconddirection opposite the first direction to form a pocket in a tibia.

In yet another form, a method for repairing a soft tissue or bone defectis provided according to the teachings of the present disclosure. Themethod can include locating a first guide relative to a distal end of afemur and guiding a first cutting member with the first guide to form abore through the femur in a first direction relative to the femur. Themethod can further include removing the first guide from the femur andmaintaining the first cutting member in the femur and using the boreformed in the femur to guide the first cutting member in a seconddirection opposite the first direction to form a pocket in a tibia.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The present teachings will become more fully understood from thedetailed description, the appended claims and the following drawings.The drawings are for illustrative purposes only of selected embodimentsand not all possible limitations, and are not intended to limit thescope of the present disclosure.

FIG. 1 is a perspective view depicting an exemplary surgical procedureincluding positioning a sizing guide relative to a cartilage defect inaccordance with the teachings of the present disclosure;

FIG. 1A is a perspective view of the sizing guide of FIG. 1 inaccordance with the teachings of the present disclosure;

FIG. 2 is a perspective view of the exemplary procedure depictingpositioning guide pins relative to the sizing guide and the femur inaccordance with the teachings of the present disclosure;

FIG. 3 is a perspective view of the exemplary procedure depictingpositioning a cartilage cutter relative to the guide pins and femur inaccordance with the teachings of the present disclosure;

FIG. 3A is a perspective view of the cartilage cutter of FIG. 3 inaccordance with the teachings of the present disclosure;

FIG. 4 is a perspective view of the exemplary procedure depictingpositioning an outer drill stop relative to the guide pins and femur inaccordance with the teachings of the present disclosure;

FIG. 5 is a perspective view of the exemplary procedure depicting adrill bit guided by one of the guide pins and the outer drill stop inaccordance with the teachings of the present disclosure;

FIG. 5A is a perspective view of the drill bit of FIG. 5 in accordancewith the teachings of the present disclosure;

FIG. 6 is a perspective view of the exemplary procedure depicting thedrill bit guided by one of the guide pins and an inner drill stop inaccordance with the teachings of the present disclosure;

FIG. 6A is a perspective view of the inner drill stop of FIG. 6 inaccordance with the teachings of the present disclosure;

FIG. 7 is a perspective view of the exemplary procedure depicting afemoral drill guide positioned relative to the cartilage defect area ofthe femur in accordance with the teachings of the present disclosure;

FIG. 7A is a perspective view of the femoral drill guide of FIG. 7 inaccordance with the teachings of the present disclosure;

FIG. 8 is a perspective view of the exemplary procedure depictingforming a bore through the femur with a drill bit in accordance with theteachings of the present disclosure;

FIGS. 8A-8C depict views of the drill bit of FIG. 8 in accordance withthe teachings of the present disclosure;

FIGS. 9-10 are perspective views of the exemplary procedure depictingpreparing the drill bit for forming a pocket in the tibia in accordancewith the teachings of the present disclosure;

FIG. 11 is an enlarged view of the drill bit of FIG. 10 illustrating adrive collar in accordance with the teachings of the present disclosure;

FIG. 11A is a sectional view of the drive collar of FIG. 11 inaccordance with the teachings of the present disclosure;

FIG. 12 is a perspective view of a tibial cutter of FIG. 12 inaccordance with the teachings of the present disclosure;

FIG. 13 is a perspective view of the exemplary procedure depicting anexemplary tibial screw implant coupled to the drill bit for optionalimplantation relative to the tibial pocket in accordance with theteachings of the present disclosure;

FIG. 13A is a partial sectional view of a tibial screw implant tap inaccordance with the teachings of the present disclosure;

FIG. 13B is a partial sectional view of the tibial screw implant of FIG.13 in accordance with the teachings of the present disclosure;

FIG. 13C is a perspective view of a trial tibial bearing in accordancewith the teachings of the present disclosure;

FIG. 14 is a perspective view of the exemplary procedure depictingpositioning a tibial bearing implant relative to the tibial pocket withan instrument in accordance with the teachings of the presentdisclosure;

FIG. 15 is a perspective view of the exemplary procedure depictingseating the tibial bearing implant relative to the tibial pocket with atibial bearing impactor in accordance with the teachings of the presentdisclosure;

FIG. 15A is a perspective view of the tibial bearing impactor of FIG. 15in accordance with the teachings of the present disclosure;

FIG. 16 is a perspective view of the exemplary procedure depictingpositioning a femoral implant relative to the femoral pocket inaccordance with the teachings of the present disclosure;

FIG. 16A is a perspective view of the femoral implant of FIG. 16 inaccordance with the teachings of the present disclosure; and

FIGS. 17-19 are perspective views of another exemplary proceduredepicting forming a tibial pocket using a bore in the femur inaccordance with the present teachings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, its application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.Although the following description is related generally to methods andsystems for repairing a cartilage defect in a knee joint, it should beappreciated that the methods and systems discussed herein can beapplicable to other bones and/or joints of the anatomy.

Exemplary embodiments are provided so that this disclosure will bethorough, and will fully convey the scope to those who are skilled inthe art. Numerous specific details are set forth such as examples ofspecific components, devices, systems and/or methods, to provide athorough understanding of exemplary embodiments of the presentdisclosure. It will be apparent to those skilled in the art thatspecific details need not be employed, that exemplary embodiments may beembodied in many different forms and that neither should be construed tolimit the scope of the disclosure. In some exemplary embodiments,well-known processes, well-known device structures, and well-knowntechnologies are not described in detail.

Turning now to FIGS. 1-16A of the drawings, various methods and systemsare disclosed in accordance with the present teachings for repairing acartilage defect in a knee joint 10. As will be discussed in greaterdetail below, pockets in a femur 14 and tibia 18 can be formed forreceiving respective implants, with the tibial pocket being formed viaaccess through a bore in the femur 14 in accordance with an exemplaryaspect of the present teachings.

With particular reference to FIGS. 1 and 1A, knee joint 10 is shown inflexion and an exemplary sizing guide 22 is shown positioned relative toa defect or lesion in the articular cartilage on one of the femoralcondyles 26. As will be discussed in greater detail below, sizing guide22 can be used to determine an appropriate size and location for afemoral implant 30 (FIG. 16A). Sizing guide 22 can include a first orbone engaging end or surface 34 and an opposite second end 38. The boneengaging surface 34 can include an arcuate shape to match the contour ofthe distal end of the femoral condyles 26. The bone engaging end 34 caninclude a base 42 having an outer perimeter 46 that corresponds in sizeand shape to an outer perimeter 48 of the femoral implant 30. In thisregard, sizing guide 22 can be provided with base 42 having a variety ofdifferent sizes that correspond to a variety of correspondingly sizedfemoral implants so as to best match the size of the patient's cartilagedefect.

A pair of cannulated outer shafts 50 and an inner or central cannulatedshaft 54 can extend from the base 42 and can define the opposite end 38.Shafts 50 and 54 can align with corresponding through bores 58 and 62,respectively, formed in base 42, as shown in FIG. 1A. In one exemplaryconfiguration, shafts 50 and 54 can include different axial lengths soas to have staggered ends to facilitate ease of use, as shown forexample in FIGS. 1 and 1A. The through bores 58 and 62 can be positionedat a predetermined distance relative to each other and remain in thesame position regardless of the different sizes provided for base 42.

Once an appropriate sizing guide 22 has been selected that has a base 42corresponding to the size of the defect or that best matches with thesize of the defect, the base 42 can be positioned over the defect suchthat the inner shaft 54 is aligned at an angle α of about 30 to 40degrees below or posterior to a longitudinal axis 66 of femur 14, asshown in FIG. 1.

Referring to FIG. 2, with the sizing guide 22 positioned as discussedabove, a guide pin 70, such as a K-wire with a threaded distal tip, canbe inserted into each of the cannulated tubes to provide three distinctseparate axes for guidance. The guide pins 70 can include a hex or othershaped proximal end 74 configured to receive a driver 78. Driver 78 canbe used to drive the threaded distal tips of guide pins 70 into femur14. In this regard, the guide pins 70 can include a length correlatingto a length of outer shafts 50 and inner shaft 54 such that the guidepins 70 can be driven into femur 14 until a distal end 82 of driver 78engages ends 86 of shafts 50 and 54. For discussion purposes, the guidepin 70 corresponding to the inner shaft will hereinafter be referred toas the inner guide pin 70 and the guide pins 70 corresponding to theouter shafts 50 will be referred to as the outer guide pins 70.

As will be discussed in greater detail below, the implanted guide pins70 can serve as a guidance system for other instruments and/orprocedures to be performed in connection with repairing the cartilagedefect in accordance with the teachings of the present disclosure. Oncethe guide pins 70 have been implanted as discussed above, the sizingguide 22 can be removed by sliding the guide 22 away from femur 14 aboutguide pins 70. In one exemplary configuration, the sizing guide 22 canbe reusable and formed of a biocompatible material, such as stainlesssteel, titanium, or the like, consistent with such purpose.

With particular reference to FIGS. 3 and 3A, an appropriately sizedcartilage cutter 100 can be selected and positioned relative to thecartilage defect about guide pins 70. Cartilage cutter 100 can include abase 104 having a bone engaging end 108 and an opposite end 112 fromwhich a cannulated impact shaft 116 extends. The cartilage cutter 100can be provided in various sizes where an outer perimeter 120 of thebase 104 varies in size and/or shape to correspond with the varioussizes of femoral implant 30 and thus base 42 of sizing guide 22. Thebone engaging end 108 of base 104 can include an outer rim 122 having asharpened cutting edge 124 extending longitudinally from end 112 and canbe used to cut an outline 126 (FIG. 9) in the cartilage around thedefect that corresponds to the outer perimeter 120 of cartilage cutter100.

End 112 of base 104 can include a pair of apertures 128 positioned onopposite sides of shaft 116 so as to correspond with the spacing ofouter guide pins 70 implanted in femur 14. As briefly discussed aboveand shown in FIG. 3, cartilage cutter 100 can be slidably received onguide pins 70 via apertures 128 and cannulated shaft 116 so as toposition outer cutting edge 124 of base 104 against the cartilage offemur 14. An impact end 132 of shaft 116 can be impacted with an impactmember 136 to cut the outline 126 in the cartilage corresponding to theouter perimeter 48 of the selected femoral implant 30 (FIG. 16A). Inthis regard, it should be appreciated that the shaft 116 and impact end132 include an axial length longer than the inner guide pin 70, as shownfor example in FIG. 3. Base 104 of cartilage cutter 100 can also includeindicia 140 providing a visual indication of a desired or maximum depthfor driving cartilage cutter 100 relative to the femur. Once thecartilage has been cut with cartilage cutter 100, the cartilage cutter100 can be removed in a similar manner as sizing guide 22 discussedabove.

As will be discussed in greater detail below, by cutting the outline 126in the cartilage, any tearing of cartilage outside the cut perimeter asa result of subsequent drilling in femur 14 can be substantiallymitigated or eliminated. In this regard, in one exemplary configuration,only the outline 126 can be cut in the cartilage with cartilage cutter100 such that cartilage is not removed by the cutting techniquediscussed above. However, it should be appreciated that cartilage withinthe perimeter outline cut into the cartilage could be removed inconnection with cutting the perimeter outline into the femoralcartilage.

In one exemplary configuration, cartilage cutter 100 can be formed as atwo-piece component where shaft 116 is removably engaged to base 104 viaa threaded connection or the like. In this configuration, shaft 116 canbe reusable and base 104 can be disposable.

With continuing reference to FIGS. 4-5A, an outer drill stop 150 can bepositioned relative to femur 14 about guide pins 70, as shown in FIG. 4.As will be discussed below, outer drill stop 150 can serve to both guidea drill bit 154 relative to the cartilage defect as well as limit adrilling depth relative to femur 14. The outer drill stop 150 caninclude a base 158 having a bone engaging end 162 and an opposite end166 from which a cannulated shaft 170 extends. Base 158 can include twoapertures 174 having an inner diameter corresponding to an outerdiameter of a portion of drill bit 154, as will be discussed below.Outer drill stop 150 can be positioned about guide pins 70 such that theouter guide pins 70 are received through apertures 174 and the innerguide pin 70 is received in cannulated shaft 170. In this regard, as canbe seen in FIG. 4, cannulated shaft 170 in cooperation with inner guidepin 70 serves to initially guide outer drill stop 150 relative to femur14. In one exemplary configuration, base 158 can include an outerperimeter 178 sized and shaped to also correspond with the outerperimeters of the selected cartilage cutter 100 and femoral implant 30.

Drill bit 154 can include a first or bone engaging end 186 and anopposite second or driver engaging end 190, as shown for example in FIG.5A. The bone engaging end 186 can include a plurality of flutes 194corresponding to a plurality of cutting edges 198, as also shown in FIG.5A. In the exemplary configuration shown, drill bit 154 includes threeflutes 194 between the corresponding three cutting edges 198. The flutes194 can extend from the bone engaging end 186 for a length 196 to a stopcollar 202. In one exemplary configuration, the flutes 194 can extendthrough the stop collar 202 so as to provide a path for bone material toexit the drill bit 154 during use. Drill bit 154 can also includethroughbore 206 sized and shaped to cooperate with the outer guide pins70 and a driver engagement portion 210 at the driver engaging end 186configured to cooperate with a drill bit driving member (not shown).

In use, drill bit 154 can be separately positioned about each of theouter guide pins 70 such that the pins are received in the throughbore206 of drill bit 154. An outer diameter 214 of the bone engaging end 186can be sized to cooperate with an inner diameter 218 of outer drill stopapertures 174, as shown in FIG. 5 with reference to FIG. 4. In thisregard, as the drill bit 154 is advanced along each of the outer guidepins 70 into respective apertures 174, the bone engaging end 186 cancooperate with the respective aperture 174 and outer guide pin 70 toself-center that aperture 174 about the associated outer guide pin 70.Drill bit 154 can be advanced relative to femur 14 until stop collar 202engages base 158, thereby limiting a depth of outer bores or pockets 226(FIG. 9) drilled in femur 14. As will be discussed in greater detailbelow, the inner diameter 230 of outer bores 226 can correspond to anouter diameter of corresponding outer projections 234 (FIG. 16A) onfemoral implant 30.

With continuing reference to FIGS. 6 and 6 a, the outer drill stop 150can be removed after forming outer bores 226 while leaving guide pins 70in place. An inner drill stop 248 can be positioned over outer guidepins 70 via corresponding apertures 252 and positioned relative to femur14, as shown in FIG. 6. Inner drill stop 248 can include a first or boneengaging side 256, a second opposite side 260 and a central drill bitreceiving aperture 264. Bone engaging side 256 can include a pair ofprojections 268 configured to be received in outer bores 226 (FIG. 9) toaid in locating and retaining inner drill stop 248 relative to bores 226and femur 14, as shown in FIG. 6A.

In the exemplary configuration illustrated, projections 268 can be inthe form of semicircles having a radius substantially corresponding to aradius of outer bores 226. With the inner drill stop 248 in place asshown in FIG. 6, drill bit 154 can be advanced over inner guide pin 70and received in aperture 264 to drill an inner bore or pocket 272 (FIG.9) in femur 14. In the exemplary configuration illustrated, inner bore272 can include a depth less than a corresponding depth of outer bores226, as shown in FIG. 9, corresponding to outer projections 234 and aninner projection 276 of femoral implant 30, as shown in FIG. 16A. Inthis regard, since drill bit 154 can be used for both the outer andinner bores 226, 272, a thickness of the inner drill stop between ends261, 262 can be greater than a corresponding thickness of the base ofouter drill stop 150. The outer and inner bores 226, 272 can hereinafteralso be referred to as the femoral or reference pocket 280 configured toreceive the femoral implant 30 (FIG. 9).

Referring additionally to FIGS. 7-8, the inner drill stop 248 can beremoved along with the guide pins 70 after forming inner bore 272, and adrill guide 290 can be positioned relative to femur 14 using bores 226,272 for locating reference and alignment. As will be discussed ingreater detail below, drill guide 290 can be used to drill a bore in thefemur 14, which will be used to prepare the tibia for receipt of atibial implant. Before locating drill guide 290 relative to femur 14,any remaining cartilage between outline 126 and bores 226, 272 in areas294 can be removed, as shown in FIG. 9. Once such cartilage is removed,drill guide 290 can be positioned relative to femur 14 using bores 226,272, as will be discussed in greater detail below.

Drill guide 290 can include a base 302 having a first or bone engagingside 306 and a second opposite side 310. A handle 314 can extend fromthe second side of base 302 and perpendicular thereto, as shown in FIGS.7 and 7A. A cannulated guide member 318 can also extend from base 302 ata 45 degree angle relative to both base 302 and handle 314. Guide member318 can be configured to receive and guide a drill bit 322 (FIG. 8), aswill be discussed below. The bone engaging side 306 can include outerand inner projections 326, 330 sized and shaped to correspond with andbe received in bores 226, 272, as shown in FIG. 7A with reference toFIG. 7. The lower or posterior outer projection 326 can include anangled portion 328 configured to aid in removing drill guide 290 at anangle from bores 226, 272 about drill bit 322, as will be discussedbelow. Once drill guide 290 is positioned relative to bores 226, 272,drill bit 322 can be received in cannulated guide member 318 andadvanced relative to femur 14 to drill a bore through femur 14, as shownin FIG. 8.

With additional reference to FIGS. 8A-8C, drill bit 322 will bediscussed in greater detail. Drill bit 322 can include a first end 338and a second end 342. First end 338 can include a pointed tip portion346 configured to engage bone and assist in a cutting operation,followed by a threaded portion 350 and a first hexagon shaped portion incross section 354, as shown for example in FIG. 8C. In the exemplaryconfiguration illustrated, tip portion 346 can include a smallerdiameter than threaded portion 350, which can include a smaller diameterthan the first hexagon shaped portion 354, as shown in FIG. 8C. As willbe discussed below in greater detail, first end 338 can receive both aquick-release driver to facilitate driving drill bit 322 through femur14, and a cutter for forming a pocket in tibia 18.

As can be seen in FIG. 8B, second end 342 can include a cutting portion362 having a standard flute that extends partially toward first end 338to a second hexagon portion 366. The second hexagon portion 366 caninclude a smaller diameter than the cutting portion 362, but the same asa third hexagon portion 368, thereby forming a shoulder 370 between thetwo portions. An annular recess 374 can be positioned between the secondhexagon portion 366 and the third hexagon portion 368, as also shown inFIG. 8B. As will be discussed in greater detail below, second end 342can be configured to both drill a bore in femur 14 as well as receive adrive collar over the cutting portion 362 to drive drill bit 322 to cuta pocket in tibia 18.

As briefly discussed above, first end 338 is configured to receive aquick-release driver 382 about first hexagon portion 354 for couplingdrill bit 322 to a driving member to drill a bore 386 in the femur, asshown in FIG. 8. As can be seen in FIG. 8, drill bit 322 can exit femur14 extra-articularly. In this regard, forming bores 226, 272 havinglongitudinal axes that are 30-40 degrees posterior to the longitudinalaxis 66 of femur 14 along with the 45 degree angle of drill guide 290can cooperate together to strategically position an exit of the drillbit 322 proximate an interior edge of the articular cartilage so as tonot exit too deep into adjacent muscle tissue or out of condyle surface26, as also shown in FIG. 8.

Once bore 386 has been formed in femur 14 as discussed above,quick-release driver 382 can be removed from drill bit 322 and drillguide 290 can then be removed from femur 14 by sliding drill guide aboutdrill bit 322. In this regard, angled portion 328 can facilitate slidingthe lower projection 326 out of bore 226 along the forty-five degreeangle of drill bit 322 relative to the longitudinal axes of bores 226,272. Drill bit 322 can then be slidably advanced to a position wherefirst end 338 is proximate the joint space 390 between femur 14 andtibia 18, as shown in FIG. 9. A cannulated drill stop member 400 can beslidably received over drill 322 via second end 342 while drill bit 322remains in femur 14. Drill stop member 400 can be advanced relative todrill bit 322 until a distal end 404 engages femur 14, as also shown inFIG. 9. A stop collar 412 can then be slidably received on drill bit 322and can be positioned relative to a proximal end 416 of stop member 400in preparation for final positioning, as will be discussed below. Stopcollar 412 can be any appropriate device that can be fixed in variouspositions relative to bit 322. In the exemplary configuration shown inFIG. 9, stop collar 412 includes a cannulated longitudinal member 424and a fastener 428 threadably engaged with member 424. As can beappreciated by one of ordinary skill in the art, fastener 428 can betightened relative to member 424 so as to advance the fastener intofixed engagement with drill bit 322 and thus maintain collar 412 in adesired position relative to drill bit 322.

Once stop collar 412 has been positioned on drill bit 322 as discussedabove, a drive collar 438 can be positioned over second end 342 of drillbit 322, as shown in FIG. 10 with reference to FIGS. 11 and 11A. Drivecollar 438 can include a first or proximal end 442 having a collarportion 446 and a hex drive protrusion 450. A cannulated portion 454 canextend from drive collar 438 up to and define a second or distal end458. The distal end 458 can include an inner drive wall having a hexagonshape 462, as shown in FIG. 11A. Cannulated portion 454 can include apredetermined length correlated to a length of the cutting portion 362of drill bit 322 such that the hexagon shaped drive wall 462 can engagethe third hexagon portion 368 when drive collar 438 is urged towardfemur 14, or can engage a second hexagon portion 366 when drive collar438 is pulled away from femur 14, as shown in FIG. 11A. Drive collar 438can be pivoted onto drill bit 322 via annular recess 374 and cut-out456. The distal end 458 can be positioned over annular recess 374 viacut-out 456 shown in FIG. 11. Engagement of the distal end 458 of drivecollar 438 with annular recess 374 can prevent drive collar 438 fromcoming off of drill bit 322 during extraction. In addition to serving adriving function, as will be discussed in greater detail below, drivecollar 438 can also serve to protect a surgeon, clinician or otherpersonnel from the cutting portion 362 of drill bit during the surgicalprocedure.

A cutter 472 can be threadably received on threaded portion 350 of bit322 for use in cutting a pocket in tibia 18, as shown in FIGS. 9A and10. In one exemplary aspect, drive collar 438 can be used to rotatedrill bit 322 via collar portion 446 to threadably engage cutter 472 viainternal female threads 476, as generally shown in FIG. 10. Pointed tipportion 346 of first end 338 can extend axially beyond cutter 472 to aidcutter 472 in initially engaging and cutting tibia 18, as shown forexample in FIG. 9A. Once cutter 472 is coupled to drill bit 322, thedrill bit 322 can be slidably advanced relative to femur 14 until cutter472 contacts tibia 18. At this point, a spacer 484 can be received ondrill bit 322 between proximal end 416 of drill stop member 400 and stopcollar 412. In one exemplary aspect, a longitudinal or axial thickness492 of spacer 484 can correspond to a depth of a pocket cut into tibia18 by cutter 472, as will be discussed in greater detail below.

Cutter 472 can include a body 512 having a first or proximal end 516 andan opposite second bone engaging end 520, as shown in FIG. 12. Body 512can define a central hub 524 and a plurality of cutting members 528,such as the three cutting members 528 illustrated in FIG. 12, thatextend radially outward from hub 524 to an annular ring 536. Eachcutting member 528 can include a cutting blade or edge 540 on a distalsurface thereof, as also shown in FIG. 12. In one exemplary aspect, thecutting blades 540 can extend radially outward to a radially outermostedge 544 of cutter 472. Central hub 524 can define an internal borehaving threads 476 configured to threadably receive threaded portion 350of bit 322 in the manner discussed above. An outer wall of hub 524adjacent the proximal end 516 can include a square shape 548 configuredto receive a tool (not shown) to aid in securing cutter 472 to drill bit322.

Once spacer 484 is positioned on drill bit 322 as discussed above, oneside of spacer 484 can be brought into contact with proximal end 416 andstop collar 412 can be brought into contact with an opposite side ofspacer 484, as shown in FIG. 10. The tibia can be rotated so that cutter472 is perpendicular to a tibial plateau of the tibia. At this point,the distal end 404 of drill stop member 400 should be contacting femur14, and cutter 472 should be in contact with tibia 18 at the locationfor the implant. Fastener 428 can be tightened to secure stop collar 412in this position, after which spacer 484 can be removed. A drill drivingmember (not shown), such as the driving member discussed above, can becoupled to hex drive protrusion 450 of drive collar 438 for drivingdrill bit 322 and cutter 472 to cut a pocket in tibia 18. In particular,drill bit 322 and cutter 472 can be advanced relative to femur 14 anddrill stop member 400 to cut a pocket 550 (FIG. 14) in tibia 18 forreceipt of a tibial bearing implant 554 (FIG. 14). Tip portion 346 ofdrill bit 322 can initially engage tibia 18 to assist in cutting pocket550. Drill bit 322 can be advanced to cut pocket 550 with cutter 472until stop collar 412 engages the proximal end 416 of drill stop member400 thereby limiting the depth of pocket 550 to a predetermined depthcorresponding to tibial bearing 554.

Pocket 550 can be formed to remove a corresponding lesion or defect intibia 18. In this regard, cutter 472 can be provided in various sizes,such as various diameters, to account for varying sizes of the tibialdefect. Tibial bearing 554 can similarly be provided in various diametersizes corresponding to the various sizes of cutter 472.

Once pocket 550 has been formed in tibia 18, a trial tibial bearing 562(FIG. 13C) can be positioned in pocket 550 in a similar manner as tibialimplant 554 is shown in FIG. 14 being positioned in pocket 550. Anexemplary instrument 568 can be used to position both trial bearing 562and bearing implant 554 in pocket 550, as will be discussed below. Ifthe tibial pocket 550 is determined not to be deep enough based on anevaluation of the trial bearing placement in pocket 550, cutter 472 canbe used to form pocket 550 deeper into tibia 18. In this regard, stopcollar 412 can be loosened from drill bit 322 and depth marking indicia564 (FIG. 10) on drill bit 322 can be used as reference marks in formingpocket 550 deeper into tibia 18.

On the other hand, if it is determined that pocket 550 has been formedtoo deep into tibia 18 and/or the sub-cortical bone is too soft, atibial adjustment screw 570 can be implanted into pocket 550, asgenerally shown in FIG. 13. Optional tibial adjustment screw 570 can beused to provide structural support for tibial bearing 554 and/or toadjust the depth of pocket 550, as will be discussed in greater detailbelow. Referencing FIG. 13B, tibial adjustment screw 570 can includeexternal threads 578 extending from a proximal end 582 to a distal end586. Proximal end 582 can include an internal blind bore 590 having ahexagonal shape 594 complimentary to the first hexagonal shaped portion354 of bit 322. In this regard, cutter 472 can be removed from bit 322and tibial adjustment screw 570 can be positioned about the first end ofbit 322 such that the first hexagonal portion 354 engages the hexagonalshape 594 of tibial screw bore 590. Drill bit 322 can then be used todrive tibial adjustment screw 570 into pocket 550, as will be discussedbelow in greater detail.

Before tibial adjustment screw 570 is coupled to drill bit 322 andimplanted into pocket 550, an optional tibial adjustment screw tap 600(FIG. 13A) can be used to tap tibia 18 for receipt of screw 570discussed above. The tibial adjustment screw tap 600 can include asubstantially similar structure and can couple to drill bit 322 in thesame manner as screw 570 and thus will not be described in detailherein. Briefly, however, screw tap 600 can include a proximal end 604,an internal blind bore 608 having a hexagonal shaped sidewall 612, and aconical shape 616 with external threads 620 extending to a distal tip624.

A screw and tap guide ring 632 can be used to guide both the tap 600and/or the screw 570, as discussed below and shown in FIG. 13. Inparticular, guide ring 632 can include an outer diameter complementaryto an inner diameter of pocket 550 such that guide ring can be snuglypositioned within pocket 550. Guide ring 632 can also include a centralthroughbore 636 sized and shaped to receive the tap 600 and/or bearingscrew 570 therethrough. It should be understood that guide ring 632 isoptional. In an exemplary aspect, guide ring 632 is removed afterimplantation of tibial screw 570 and before implanting tibial bearing554 in pocket 550. It should also be understood that both the tap 600and screw 570 can be coupled to drill bit 322 without having to removethe drill bit from femur 14.

With screw tap 600 coupled to drill bit 322 in the manner discussedabove, tibia 18 can be tapped in a central location of pocket 550 usingoptional guide ring 632 as a guide. The tap 600 can be threaded intotibia 18 until a proximal end of the threads is flush with a bottom ofpocket 550. In one exemplary aspect, drive collar 438 can be used torotate drill bit 322 instead of the drive member to perform the tappingand implanting operation associated with screw 570. The tap 600 can thenbe removed from drill bit 322 and tibial screw 570 can be coupled to bit322 in the manner discussed above. Tibial screw 570 can be threaded intothe tapped threads in tibia 18 using drive collar 438. The guide ring632 can be optionally removed before implanting screw 570, as discussedabove. Screw 570 can be provided in various sizes, such as variouslengths and diameters. Tap 600 can therefore also be provided in varioussizes corresponding to the various sizes of screw 570. The guide ring632 can also be provided with various through bore sizes.

First end 338 of drill bit 322 can then be slidably removed from screw570 and the trial bearing 562 can again be positioned in pocket 550 tocheck the fit of the trial bearing 562. If it is determined that thetrial bearing 562 needs to be raised toward the articular surface of thetibia 18 (i.e., toward femur 14), then first end 338 can be insertedthrough a central throughbore 644 of the trial bearing 562 and intoengagement with screw 570. Drill bit 322 can then be rotated in anappropriate direction to raise the trial bearing 562 to an appropriateposition. In this regard, it should be appreciated that the diameter ofthrough bore 644 is large enough to allow drill bit 322 to pass through,but smaller in diameter than screw 570 so that the trial bearing 562 canbe raised or lowered when screw 570 is turned. Once screw 570 isadjusted to place the trial bearing 562 in the appropriate position,drill bit 322 can be removed from femur 14 along with the associatedstop collar 412, drive collar 438 and drill stop member 400.

Before implanting the femoral and tibial implants 30, 554, a femoraltrial (not shown) can be positioned in the femoral pocket 280 and thetrial bearing 562 can remain removably positioned in tibia 18. Thefemoral trial can be substantially similar to femoral implant 30 shownin FIG. 16A such that the femoral trial will not be discussed in furtherdetail herein. With the femoral and tibial trials in place, the leg canbe articulated to check for a smooth transition between the respectivetrials and surrounding articular cartilage.

The femoral and tibial trials can then be removed and the femoral andtibial pockets 280, 550 can be prepared for receipt of respectiveimplants 30, 554. In one exemplary aspect, bone cement can be used tosecure the implants 30, 554 to the respective pockets 280, 550. In thisaspect, bone cement can be applied to one or both of the bottom ofpocket 550 and the bottom of tibial bearing 554. Instrument 568 can thenbe used to position tibial bearing 554 into pocket 550, as shown in FIG.14. Once tibial bearing 554 is placed in pocket 550, a tibial bearingimpactor 652 (FIG. 15) can be used to seat bearing 554 into pocket 550and, if previously implanted, against bearing screw 570.

As can be seen in FIG. 15A, tibial bearing impactor 652 can have agenerally C-shaped body 656 so as to fit around femur 14. Body 656 caninclude a first impact receiving end 660 configured to be impacted withimpact member 136, and an opposite bearing engaging end 668. Bearingengaging end 668 can include a linear portion 672 having a protrusion676 at a free end 680 configured to engage bearing 554, as shown inFIGS. 15 and 15A.

With additional reference to FIGS. 16 and 16A, preparation for andimplantation of femoral implant 30 will now be discussed. Femoralimplant 30 can be provided with a variety of outer perimeter 48 sizesand can include a femoral pocket engaging side 692 and an oppositearticulation side 696. Bone engaging side can include the outerprojections 234 corresponding to outer bores 226 and the innerprojection 276 corresponding to inner bore 272, as shown in FIG. 16A.The outer perimeter 48 of each implant 30 can be sized and shaped tocorrespond with outline 126 cut in the femoral articular cartilage withcartilage cutter 100 discussed above. In one exemplary configuration,the outer perimeter 48 can vary in size to correspond with the outline126 while the outer and inner projections 234, 276 remain the same amongthe implants 30.

In the exemplary aspect where bone cement can be used as a securingmethod, bone cement can similarly be applied to the pocket engaging side692 of femoral implant 30 and a bottom of bores 226, 272 of pocket 280.Implant 30 can then be positioned in femoral pocket 280 such that outerprojections 234 are received in outer bores 226 and inner projection 276is received in inner bore 272, as shown in FIG. 16 with reference toFIG. 15. Implant 30 can then be seated in pocket 280 using a femoralimpactor 702 and impact member 136, as also shown in FIG. 16.

With additional reference to FIGS. 17-19, an alternative method andsystem for forming tibial pocket 550 will now be discussed, where likereference numerals refer to like features previously introduced anddiscussed. A substantially C-shaped guide member 750 can be positionedas shown in FIG. 17 to extend around the condyle area of femur 14. Guidemember 750 can include a threaded bore 754 at a first or upper end 758and a second opposite end 760 configured to rest on tibia 18 and receivea distal end 762 of drilling member 764, as shown for example in FIG.17. Threaded bore 754 can threadably receive a cannulated bullet 766therethrough.

Bullet 766 can be threadably advanced until it engages femur 14 tosecure bullet 766 and guide relative to femur 14, as also shown in FIG.17. Drilling member 764 can then be inserted through cannulated bullet766 and rotated with a driving member (not shown) to drill a bore 770though femur 14. Drilling member 764 can be advanced relative to femur14 until distal end 762 engages second end 760.

With particular reference to FIGS. 18 and 19, drilling member 764 can beremoved from bullet 766 and the bullet can be disengaged from femur 14so as to provide for removal of guide member 750 from the anatomy. Adrive shaft 774 can then be slidably inserted through bore 770 until athreaded distal end 778 is positioned relative to joint space 390.Cutter 472 can then be threadably engaged to distal end 778 in the samemanner as discussed above in connection with drill bit 322. Drive shaft774 can be rotated with any suitable drive member to form pocket 550 intibia 18, as generally shown in FIG. 19 with reference to pocket 550 ofFIG. 14. The trial bearing 562, screw 570 and/or tap 600 can then beused in a similar manner as discussed above to check the fit of pocket550. Tibial bearing 554 can then be implanted using the technique andinstruments discussed above.

While one or more specific examples have been described and illustrated,it will be understood by those skilled in the art that various changesmay be made and equivalence may be substituted for elements thereofwithout departing from the scope of the present teachings as defined inthe claims. Furthermore, the mixing and matching of features, elementsand/or functions between various examples may be expressly contemplatedherein so that one skilled in the art would appreciate from the presentteachings that features, elements and/or functions of one example may beincorporated into another example as appropriate, unless describedotherwise above. Moreover, many modifications may be made to adapt aparticular situation or material to the present teachings withoutdeparting from the essential scope thereof.

What is claimed is:
 1. A method for repairing a soft tissue or bonedefect, comprising: selecting one of a plurality of sizing guides havinga base perimeter size corresponding to a size of the defect, each basehaving a different perimeter size and each base having a plurality ofapertures spaced apart a predetermined distance from each other, thepredetermined distance being the same for each of the plurality ofsizing guides; positioning the base of the selected one of the sizingguides against a distal end of the femur relative to the defect;positioning a plurality of guide wires through the plurality ofapertures in the base of the selected one of the sizing guides andfixing the plurality of guide wires to the distal end of the femur suchthat the plurality of guide wires are parallel to each other; andpositioning a first guide over the plurality of guide wires and againstthe distal end of the femur to guide a first cutting member relative tothe femur.
 2. The method of claim 1, wherein positioning a plurality ofguide wires through the plurality of apertures in the base of theselected one of the sizing guides includes positioning a plurality ofguide wires through a plurality of cannulated members extending from thebase of the selected one of the sizing guides, the plurality ofcannulated members being aligned with the plurality of apertures.
 3. Themethod of claim 2, wherein positioning the base of the selected one ofthe sizing guides against a distal end of the femur includes positioningthe base of the selected one of the sizing guides against a distal endof the femur such that a longitudinal axis of each of the plurality ofcannulated members is between approximately thirty and forty degreesposterior to a longitudinal axis of the femur and a longitudinal axis ofthe plurality of guide wires is correspondingly between approximatelythirty and forty degrees posterior to the longitudinal axis of thefemur.
 4. The method of claim 2, further comprising: selecting a softtissue cutting member from a plurality of soft tissue cutting memberseach having a different base perimeter size corresponding to thedifferent base perimeter sizes of the plurality of sizing guides, theselected soft tissue cutting member having a base perimeter sizecorresponding to the base perimeter size of the selected one of thesizing guides; positioning the selected soft tissue cutting member aboutthe plurality of guide wires such that the plurality of guide wires arereceived in a corresponding plurality of internal bores of the selectedsoft tissue cutting member; and cutting a perimeter outline in the softtissue relative to the defect.
 5. The method of claim 4, wherein cuttinga perimeter outline in the soft tissue relative to the defect includesimpacting an elongated shaft of the selected soft tissue cutting memberwith an impacting member to urge a cutting edge into the soft tissue tocut the perimeter outline.
 6. The method of claim 1, wherein positioninga first guide over the plurality of guide wires and against the distalend of the femur includes: positioning a first cutting member stop guiderelative to the defect using the plurality of guide wires as a locatingreference for the first cutting member stop guide; and using the firstcutting member stop guide to guide the first cutting member to formouter pocket portions of a reference pocket configured to receive afemoral implant.
 7. The method of claim 6, wherein using the firstcutting member stop guide to guide the first cutting member to formouter pocket portions of a reference pocket includes: positioning thefirst cutting member stop guide about the plurality of guide wires suchthat a pair of outer guide wires of the plurality of guide wires arereceived in a pair of outer apertures positioned in a base of the firstcutting member stop guide; and positioning the first cutting member overeach of the pair of outer guide wires such that the first cutting memberis received in and guided by each of the outer apertures to form theouter pocket portions of the reference pocket.
 8. The method of claim 7,further comprising self-centering the first cutting member stop guideabout each of the pair of outer guide wires upon the first cuttingmember being slidably received in each of the corresponding outerapertures of the first cutting member stop guide.
 9. The method of claim6, further comprising providing the first cutting member with a boneengaging end having a cutting portion extending for a predeterminedlength to a stop collar, where the predetermined length corresponds to apredetermined thickness of the outer apertures of the first cuttingmember stop guide to thereby limit a cutting depth of the outer pocketportions.
 10. The method of claim 6, further comprising: removing thefirst guide over the plurality of guide wires; positioning a secondcutting member stop guide over the plurality of guide wires and relativeto the outer pocket portions of the reference pocket; positioning thefirst cutting member over a central guide wire of the plurality of guidewires and into a central aperture formed in the second cutting memberstop guide; and using the central guide wire and central aperture toguide the first cutting member to form an inner pocket portion of thereference pocket in the femur.
 11. The method of claim 10, whereinpositioning a second cutting member stop guide over the plurality ofguide wires and relative to the outer pocket portions of the referencepocket includes positioning the second cutting member stop guide overthe plurality of guide wires such that the central aperture ispositioned over the central guide wire and projections extending from abone engaging side of the second cutting member stop guide are receivedin the outer pocket portions.
 12. The method of claim 10, wherein usingthe central guide wire and central aperture to guide the first cuttingmember to form an inner pocket portion of the reference pocket includesadvancing the first cutting member relative to the second cutting memberstop guide until a stop collar on the first cutting member engages anouter surface of the central aperture opposite the bone engaging side ofthe second cutting member stop guide.
 13. The method of claim 10,wherein using the central guide wire and central aperture to guide thefirst cutting member to form an inner pocket portion of the referencepocket includes forming the inner pocket portion to have a depthrelative to an outer surface of the distal end of the femur less than acorresponding depth of the outer pocket portions of the referencepocket.
 14. The method of claim 10, further comprising: removing thesecond cutting member stop guide over the plurality of guide wires;removing the plurality of guide wires; and locating a second guiderelative to the reference pocket such that a pair of outer projectionson a bone engaging side of the second guide are positioned in the outerpocket portions of the reference pocket and an inner projectionextending from the bone engaging side of the second guide is positionedin the inner pocket portion.
 15. The method of claim 14, furthercomprising guiding a second cutting member with the second guide in afirst direction relative to the femur to form a bore through the femur.16. The method of claim 15, wherein guiding a second cutting member withthe second guide in a first direction relative to the femur to form abore through the femur includes guiding the second cutting member at anangle of approximately forty-five degrees relative to a longitudinalaxis of the outer and inner pocket portions.
 17. The method of claim 16,further comprising: providing a posterior one of the pair of outerprojections of the second guide with a surface angled at approximatelyforty-five degrees relative to a longitudinal axis of the outer andinner projections; and removing the second guide from the femur aboutthe second cutting member while maintaining the second cutting member inthe femur such that the second guide is removed from the femur at anangle of approximately forty-five degrees relative to the longitudinalaxis of the inner and outer projections and the angled surface of theposterior one of the outer projections facilitates the removal of thesecond guide.
 18. The method of claim 15, wherein guiding a secondcutting member with the second guide in a first direction relative tothe femur to form a bore through the femur includes: forming the firstbore in the femur with a first end of the second cutting member; andmaintaining the second cutting member in the femur and using the boreformed in the femur to guide the second cutting member in a seconddirection opposite the first direction to form a pocket in a tibia usinga second opposite end of the second cutting member.
 19. The method ofclaim 18, further comprising coupling a cutting device to the second endof the second cutting member while maintaining the second cutting memberin the femur and forming the tibial pocket approximately perpendicularto a tibial plateau of the tibia.
 20. The method of claim 10, furthercomprising implanting the femoral implant relative to the distal end ofthe femur such that the femoral implant is positioned in the referencepocket with inner and outer projections of a bone engaging side of thefemoral implant being received in the corresponding inner and outerpocket portions of the reference pocket.
 21. The method of claim 1,wherein positioning a plurality of guide wires includes positioningthree guide wires.
 22. A method for repairing a soft tissue or bonedefect, comprising: forming a reference pocket in a distal end of afemur relative to the soft tissue or bone defect, the reference pocketconfigured to receive a femoral implant; guiding a first cutting memberrelative to the reference pocket to form a bore through the femur in afirst direction relative to the femur by driving a first end of thefirst cutting member to form the bore in the femur with a secondopposite end of the first cutting member; maintaining the first cuttingmember in the femur and using the bore formed in the femur to guide thefirst cutting member in a second direction opposite the first directionto form a pocket in a tibia; coupling a proximal end of a fastenerimplant to the second end of the first cutting member while maintainingthe first cutting member in the femur; and rotatably driving the secondend of the first cutting member to drive the fastener implant into thetibia through a bottom of the tibial pocket.
 23. The method of claim 22,further comprising inserting a trial tibial bearing in the tibial pocketto gauge a depth of the tibial pocket, the trial tibial bearing engagingthe proximal end of the fastener implant and including a central throughbore.
 24. The method of claim 23, further comprising: positioning thefirst end of the first cutting member through the central through boreof the trial bearing and into engagement with the proximal end of thefastener implant; and rotatably driving the first cutting member via thesecond end to raise or lower the fastener implant relative to the bottomof the tibial pocket to adjust a height of the trial bearing relative tothe tibial pocket while maintaining the first cutting member in thefemur.
 25. The method of claim 24, further comprising removing the trialtibial bearing and implanting a tibial bearing in the tibial pocket. 26.The method of claim 22, further comprising providing the fastenerimplant with external threads and a hex drive female coupling extendinginto the proximal end and configured to engage a complementary hex driveportion of the first end of the first cutting member.
 27. A method forrepairing a soft tissue or bone defect, comprising: forming a referencepocket in a distal end of a femur relative to the soft tissue or bonedefect, the reference pocket configured to receive a femoral implant;guiding a first cutting member relative to the reference pocket to forma bore through the femur in a first direction relative to the femur bydriving a first end of the first cutting member to form the bore in thefemur with a second opposite end of the first cutting member; andmaintaining the first cutting member in the femur and using the boreformed in the femur to guide the first cutting member in a seconddirection opposite the first direction to form a pocket in a tibia bydriving the second end of the first cutting member to form the pocket inthe tibia using the first end of the cutting member, wherein driving thesecond end of the first cutting member to form the pocket in the tibiausing the first end of the cutting member includes: selecting a cuttingdevice corresponding to a size of a defect in an articular surface ofthe tibia; coupling the cutting device to the first end of the firstcutting member; rotatably driving the cutting member via the second endof the first cutting member to form the pocket in the tibia with thecutting device; and the method further comprising selecting a tibialbearing having a size corresponding to the selected cutting device andimplanting the tibial bearing in the tibial pocket.
 28. A method forrepairing a soft tissue or bone defect, comprising: locating a firstguide relative to a distal end of a femur; guiding a first cuttingmember with the first guide to form a bore through the femur in a firstdirection relative to the femur by rotatably driving a first end of thefirst cutting member to form the bore in the femur with a secondopposite end of the first cutting member; removing the first guide fromthe femur; and maintaining the first cutting member in the femur andusing the bore formed in the femur to guide the first cutting member ina second direction opposite the first direction to form a pocket in atibia by rotatably driving the second end of the first cutting member toform the pocket in the tibia using the first end of the first cuttingmember; and forming a reference pocket in a distal end of a femurrelative to the soft tissue or bone defect, the reference pocketconfigured to receive a femoral implant, wherein locating a first guiderelative to a distal end of a femur includes locating a first guiderelative to the reference pocket, wherein the first cutting member isrotatably driven at the first end relative to a posterior side of thefemur to from the bore in the femur, and the first cutting member isrotatably driven at the second end relative to an anterior side of thefemur to form the pocket in the tibia.
 29. A method for repairing a softtissue or bone defect, comprising: locating a first guide relative to adistal end of a femur; guiding a first cutting member with the firstguide to form a bore through the femur in a first direction relative tothe femur by rotatably driving a first end of the first cutting memberto form the bore in the femur with a second opposite end of the firstcutting member; removing the first guide from the femur; and maintainingthe first cutting member in the femur and using the bore formed in thefemur to guide the first cutting member in a second direction oppositethe first direction to form a pocket in a tibia by rotatably driving thesecond end of the first cutting member to form the pocket in the tibiausing the first end of the first cutting member; and forming a referencepocket in a distal end of a femur relative to the soft tissue or bonedefect, the reference pocket configured to receive a femoral implant,wherein locating a first guide relative to a distal end of a femurincludes locating a first guide relative to the reference pocket,wherein rotatably driving the second end of the first cutting member toform the pocket in the tibia using the first end of the first cuttingmember includes: coupling a drive collar over a cutting portion at thesecond end of the first cutting member such that the drive collarengages a drive coupling portion of the first cutting member adjacentthe cutting portion; threadably engaging a cutting device to a threadedportion of the first cutting member, the threaded portion being adjacenta cutting tip at a terminal end at the first end of the first cuttingmember; and rotatably driving the drive collar and guiding the firstcutting member in the second direction to form the tibial pocket withthe cutting device.
 30. The method of claim 29, wherein rotatablydriving a first end of the first cutting member to form the bore in thefemur includes attaching a driver coupling to a drive coupling portionof the first cutting member adjacent the threaded portion at the firstend.
 31. The method of claim 29, further comprising: positioning acannulated stop member over a portion of the first cutting memberextending from the anterior side of the femur such that a first end ofthe stop member engages the femur and the second end of the firstcutting member extends beyond an opposite second end of the stop member;and rotatably driving the drive collar and guiding the first cuttingmember in the second direction relative to the stop member to form thetibial pocket with the cutting device.
 32. The method of claim 31,further comprising: positioning a spacer over the second end of thefirst cutting member and into engagement with the second end of the stopmember; positioning a stop collar over the second end of the firstcutting member and into engagement with the spacer; fixing the stopcollar to the first cutting member and removing the spacer, wherein anaxial length of the spacer sets a cutting depth for the tibial pocket;and rotatably driving the drive collar and guiding the first cuttingmember in the second direction until the stop collar engages the stopmember to form the tibial pocket with the cutting device.
 33. The methodof claim 32, further comprising: positioning the tibia until a tibialplateau of the tibia is substantially parallel to the cutting device;moving the first cutting member in the second direction until thecutting tip engages the tibia before fixing the stop collar to the firstcutting member; and driving the first cutting member in the seconddirection via the drive collar to form the tibial pocket with thecutting device.